Am I Suitable for
All-on-4 Implants?

Moderate bone loss is not a barrier to All-on-4 — it is the situation the technique was designed around. Tilting the two back implants lets them anchor in bone you still have rather than bone that would have to be rebuilt first, which is why so many people who were told they needed a graft turn out not to need one. Severe bone loss is a genuinely different question, and only a scan settles it.

Bone is lost because it is no longer being used. The bone around a natural root is maintained by being loaded: every bite sends force down through the root and the bone responds by keeping itself dense. Remove the tooth and that signal stops. The ridge resorbs quickly in the first year after an extraction and then keeps shrinking slowly for the rest of your life. A denture does not halt it, because resting on the gum does not load bone the way a root does. That is why long-term denture wearers so often have a flat ridge and a denture that needs relining every few years.

What matters for planning is that the loss is uneven. In the upper jaw the back goes first and goes furthest, with the sinus dropping down into the space as the bone beneath it thins. In the lower jaw the ridge shrinks towards the nerve canal that runs through it. The front of both jaws, where the canine and incisor roots sat, stays deeper and denser for longer. All on 4 implants bone loss planning is built on that pattern: the front two implants go in upright into the bone that survives best, and the back two are tilted forwards so their length lies in that same solid region, clearing the sinus above and the nerve below while the visible top of the implant still emerges far enough back to support the arch.

The 3D CT scan is what turns this from a hope into a plan. It measures the height of bone below the sinus floor and above the nerve canal, the width of the ridge at every point, the density of what is there, and the exact route the nerve takes. Every implant’s position, angle, length and diameter is worked out from those measurements before you come in for surgery.

Sometimes the scan shows there is not enough, and we will tell you so plainly. If the ridge is too narrow or too shallow even at the front, four implants cannot be placed with the stability an arch needs. The realistic routes then are bone grafting or a sinus lift to rebuild what is missing, which adds months to the plan but is well established — and which is covered by the All-on-4 price where it is what makes All-on-4 possible for you — or, where the upper jaw has lost a great deal of bone, zygomatic implants, which are longer and anchor in the cheekbone, bypassing the missing bone altogether. We will not place implants into bone that cannot hold them.

There are four situations in which we would point you somewhere else: you still have enough healthy teeth worth keeping, your bone loss is beyond what four implants can carry, you are not in a position to keep up the daily cleaning and the appointments, or your gum disease has not yet been brought under control.

You still have sound teeth on that arch. All-on-4 replaces the whole arch, which means removing whatever teeth are left on it. If several of yours are healthy with good bone around them, taking them out to fit a full arch is a bad trade — natural teeth have a ligament, a sense of bite pressure and a resilience no implant reproduces. Replacing only what is missing with individual dental implants or a bridge keeps what you have.

Your bone loss is severe. Where the scan shows too little bone for four stable implants, grafting or zygomatic implants may be the route — but they are more surgery, and not everyone wants that. A well-made conventional denture or an implant-retained denture on two implants is a legitimate answer at a fraction of the cost and the surgical burden.

You cannot, or will not, maintain it. A fixed arch has to be cleaned in your mouth, by you, every day. If arthritis, a tremor, limited dexterity or poor eyesight make that genuinely hard, or if you know yourself well enough to know you will not keep it up, something removable that you can take out and clean under a tap will serve you better and last longer. That is not a consolation prize; it is the right tool for the situation.

Your gum disease is active. This one is a delay rather than a refusal. Untreated gum disease has to be stabilised before implants go in, because the same bacteria that destroyed bone around your teeth will do the same around an implant. Once it is under control and your cleaning has changed, the conversation reopens.

We would rather turn a case down than take on one we do not believe in, and the free consultation exists partly so that we can. If All-on-4 is not right for you, you will leave knowing why and knowing what is.